Opinion: Poor Coverage for the Working Poor by Susan J. Stabile

Access to affordable health care is a matter of life and death. The Institute of Medicine reports that uninsured adults are 25 percent more likely to die prematurely than others. The Urban Institute reported that, in 2006, at least 22,000 adults in the United States died because they lacked health insurance.

Nonetheless, some 46 million people in the United States lack health insurance. Of these, eighty percent – more than 36 million – work or belong to a family in which at least one person is employed. Predictably, a significant number of workers lacking insurance coverage are lower-income employees who often work two or more jobs, and yet cannot make ends meet.

For the working poor, not having employer-provided health insurance frequently means not having any coverage. Individual health insurance is prohibitively expensive for all but the wealthy, even assuming the ability to qualify for individual insurance, which many people without employer-provided coverage cannot. Medicaid, which serves only the very poorest of the poor and often fails to provide adequate benefits, does not close the gap.

The number of workers without employer-provided medical coverage is likely to grow substantially. Concerned about rising costs, employers are increasing employee premiums and co-payments, cutting benefits or eliminating coverage altogether. Many employers increasingly are hiring part-time or independent contractors, who typically do not receive benefits, to perform tasks previously performed by full-time workers.

As affordable employer-sponsored health insurance is becoming scarcer, rising health care costs make it increasingly difficult for those without insurance to pay for necessary care. No insurance typically means choosing between medical care and other basic necessities. Thus, uninsured adults typically do not receive preventive care, fail to fill prescriptions and skip medications for chronic conditions such as asthma and diabetes. A Commonwealth Fund survey found that the uninsured have difficulty paying for food, heat or rent because of their medical bills.

Why, in a country as rich as the United States, do some people die because they have no access to affordable health care?

In large part, the problem stems from the link between health insurance and employment. Wage controls during World War II combined with a tax system that provides generous tax breaks for employer-provided care fueled growth of an employer-based system of providing health insurance. Federal law regulating employee benefits has effectively accepted the premise of an employment-based, yet voluntary, system.

Perhaps the employment-based system once worked, but it doesn’t now. In an increasingly global marketplace, providing medical care causes severe economic strain on U.S. employers competing with companies abroad who do not incur health insurance costs because their countries have nationalized health care. Moreover, small employers are finding that they simply can not afford the cost of health coverage.

Lamentably, there is no easy fix. Most Americans have no appetite for anything approaching national health care, nor is there a willingness to impose on employers a legal obligation to provide health care to their employees. That leaves us with finding ways to reduce the cost of medical care and insurance and providing vehicles that allow people without employer-provided insurance to purchase insurance on their own. This is no small order and, as the current presidential campaign reveals, there is substantial dispute among policymakers about how to address the problem.

What is beyond dispute is that the system we have now – where people die because they cannot afford basic health care – is unacceptable. In Pacem in Terris, Pope John XXIII identified health care as among the basic rights flowing from the dignity of the human person. In an address to the United Nations, Pope John Paul II included as among the human rights endorsed by the Catholic Church the right to sufficient health care. The American bishops have also been vocal in their stance that access to adequate health care is a basic right necessary for humans to realize the fullness of their dignity. There may not be an easy solution, but we must continue to work toward finding a means of providing access to medical care for everyone.

Author:Susan J. Stabile is the Robert and Marion Short Distinguished Chair in Law at the St. Thomas School of Law and is a Fellow of the Holloran Center for Ethical Leadership and on the Advisory Board of the Terrence J. Murphy Institute for Catholic Thought, Law and Public Policy. She is among the nation’s leading scholars on employee benefits and on the intersection of Catholic social thought and the law.